Arthroplasty patients and nickel sensitization: What do patch test and lymphocyte transformation test tell us

Immunological sensitization to metals is a potential elicitor of arthroplasty failure. Since nickel (Ni) allergy is the most frequent contact allergen for cutaneous contact allergic reactions, we assessed the relation between patch test reactivity and LTT reactivity to Ni in 2 groups of patients: eczema patients without implants (30 without and 38 with cutaneous metal intolerance, CMI, e.g., eczema to jewelry, jeans button) and arthroplasty patients (100 without and 200 with complications). After establishing the appropriate in vitro Ni test concentrations, a good correlation between patch test and LTT reaction was seen in the first patient group. It was also found that “self-reported Ni allergy,” e.g., CMI was only in one-third of the patients verified to be Ni allergy. In arthroplasty patients with complications, higher patch test reactivity and LTT reactivity was found—but to some extent was also found in symptom-free arthroplasty patients. Thus identification of further characteristics is needed to reveal metal implant allergy.